Posts Tagged dental implants
Major Implant Case
Posted by eric in Uncategorized on July 9th, 2010
This young gentleman who rides a motorbike got involved in an accident and lost a number of teeth along with fair chunks of bone from both upper and lower jaws. A major dental instituion in Singapore indicated elaborate implant restorations costing him an arm/leg and also numerous visits, hospital stays etc. We simplified the treatment plan for him. The case is still ongoing, but he is quite happy so far.
There is adequate bone width on the mandible, thanks to the torus mandibularis. We managed to place 3 implants.
The upper is a problem. The bone was thin and bone height was also insufficient.
Instead of doing a major bone grafting procedure, we decided to do crown lengthening on the right central incisor to bring the gum level to that of the implants.
A wisdom tooth was removed from the patient’s lower right side. Buccal bone was taken from there. Next, we did a ridge split and successfully placed 1 implant replacing the left central. The ridge over the left lateral was too thin. We grafted the autogenous bone from the mandible.
1 month after surgery. Crown lengthening on the upper central has been successful. The lower implants have been loaded with temporary crowns.
Check out the occlusion. The patient has a Cl 3 bite. We aim to give him a much more aesthetic profile without costing him too much.
2 months post op. We did a screw-retained bridge for his lower. Second stage surgery was done on the upper and temporary splinted crowns were loaded.
4 months post op, the final implant replacing the upper left lateral was placed into grafted bone. His bite has been improved.
Immediate & Conservative
Posted by eric in Uncategorized on June 21st, 2010
Immediate implant placement after extractions has numerous advantages.
1. Implant placed immediately after extraction, so no extra surgery for the patient.
2. Bone and soft tissue preservation.
3. Option to do conservative flapless surgery.
4. Faster healing.
Biggest disadvantage:
Outcome highly dependent on skill of the surgeon. It is very difficult to drill into an extraction socket and place the implant in an ideal position.
This technique is also not suitable for teeth which show signs of chronic infection (cysts etc).
The middle aged female patient had a fractured post crown, upper left central incisor. A Flexite immediate denture was prepared for her on the day of the extraction.
Flexite denture on the cast.
Another view of the Flexite denture.
The crown was separated from the root.
We then extracted the root. It was difficult as we had to make sure that no bone was lost or damaged during the extraction.
The socket had excellent bone walls on all sides. No chronic infection. Conditions for immediate implant placement were fulfilled.
Dr Chan placing an Osstem GSII 4.5×10mm implant.
Good primary stability meant that we could place a healing abutment on top of the implant.
It’s a bit closer to the lateral than the central, but the xray shows that the position was acceptable.
The temporary Flexite denture was tried in the mouth. Note that no scalpels were used for this surgery. We expect minimal pain, swelling and faster healing.
The implant should be ready for loading in 2-3 months. Both bone and soft tissue should be well preserved for an aesthetic outcome.
Implant Bridge
Posted by eric in Uncategorized on June 17th, 2010
This gentleman wants to replace missing teeth on his lower right jaw. We placed 2 implants for him and then fabricated a screw-retained PFM bridge.
Implants placed painlessly in one stage surgery. Healing abutments were placed and second stage surgery avoided.
Healing abutments removed.
Bridge fitted and torqued in at 25Ncm for each abutment screw.
Screw access blocked with cotton pellet and flowable opaque resin.
Denture Support
Posted by eric in Uncategorized on May 20th, 2010
Not all mouths requiring dentures are the same. Some mouths are more difficult than others. This is especially so in the case of the lower free end saddle.
With no tooth behind the denture, the free end of the denture will sink into the soft tissue every time the patient bites on that side.
There is virtually no denture design that can eliminate the sinking problem completely. However, this problem can be eliminated with implant support.
This looks like an ordinary lower free end saddle denture.
It’s actually a flexible denture. Note that there are no metal grips, just a thick pink flexible nylon grip on the premolar.
Such cases are often difficult to manage because free end saddle dentures will sink at the end, causing discomfort during chewing.
Upon removing the denture, you can see 2 “buttons” at the ends of the lower ridge on either side. These are implants fitted with healing abutments which hold the denture up and prevent it from sinking. Patients with these implant supported dentures can function much better than those without them.
Single Implant For An Actress
Posted by eric in Uncategorized on May 12th, 2010
This young actress showed up at our clinic with a hopeless premolar on her right side. As her job requires her to look good in front of the camera all the time, she cannot afford to go without a tooth. We extracted her tooth and inserted a tiny one-tooth Flexite immediate denture. With pink coloured nylon claps and no coverage of her palate, she was able to look good before the camera and not have a denture plate interfere with her speech immediately after her extraction. 2 months after extraction, she came in for implant surgery. The healing was not very good and the bone quality not as good as we had wanted it to be, but we managed to insert a 4.5mmx8.5mm Osstem GSII implant into the space.
The extraction space after 2 months. Healing is not perfect, making the surgery a challenging one.
The implant is in place. The blue fixture mount was removed and the wound was stitched up. She reported only mild discomfort after surgery and went straight back to work. The restoration phase of the treatment will take place in 3 months. We will post the updates then.
2 months post-op! Our beautiful actress showed up. We relieved her of her Flexite denture, did a surgical exposure of her implant and attached an abutment to it. Sorry, we were so excited we didn’t clean up the area before taking this picture.
After that, we placed a temporary crown over the abutment. We will wait another 2 weeks for the cut gums to heal, at which time we’ll take impressions for the permanent crown. Sorry, we were so excited we didn’t clean up the area before taking this picture.
The finished product.
The patient had some reaction to the temporary crown material. The inflammation is expected to clear in a couple of days.
A very daring super close up. The gums have been pushed aside by the temporary crown. They will soon settle in nicely with the new crown. The patient has her tooth back.
Immediate Post Extraction Implant Placement
Posted by eric in Uncategorized on May 12th, 2010
It’s not easy to place implants into extraction sockets, but there are several benefits in doing so.
1. Avoid surgery. Extract and place implant immediately. No waiting.
2. Preserve bone. Even if you can’t afford to pay $3000 for a complete implant restoration, you can pay $1250 to place a sleeping implant and preserve bone.
Fractured lower incisor needs to be extracted.
The fractured tooth.
Tooth socket cleaned out.
Implant inserted. This is a Dentium Superline 3.8mmx10mm
Implant in place.
Radiographic view.
Better Late Than Never
Posted by eric in Uncategorized on May 6th, 2010
This foot reflexologist was scheduled for implant surgery 2-3 months after his front tooth was extracted. It’s been almost 6 months now and the bone around the extraction site has resorbed significantly, making implant surgery challenging.
If you have an implant to do, do not delay until bone loss makes the surgery difficult.
Look at the depression in the bone around the area of the left central incisor. It wasn’t there last year.
Gum flap lifted. See how thin the bone is. Definitely a challenging case not for beginners.
This is an Osstem GSII 3.5mmx10mm implant. We chose this implant for its excellent self-tapping capability. It cuts and expands bone without breaking it.
Implant Risk Factors: Implant Fracture
Posted by admin in Uncategorized on February 20th, 2010
Any experienced implant practitioner would have seen a good number of failures. From a surgical standpoint, success rate can be well over 90%. It’s not difficult to achieve such success rates because all that is needed to determine success of the implant is osseointegration - the process whereby bone grows onto the implant surface and “fuses” with it. This implant can then be loaded with a crown.
What happens after loading? It’s just like what happens after marriage. Nobody can be certain as many factors come into play. There are patients with poor oral hygiene. There are patients who grind their teeth at night. There are patients who love to chew on bones to get to the marrow. There are patients who abuse their teeth in ways we can’t even imagine. Practitioners who handle restorations and follow up over a period of time will be able to tell you that implants restorations can be highly problematic over the long term. Some patients will be quite happy with their implant restorations. Some will need to see their dentist every few months for some adjustments. The most common problems are screw coming loose, gum inflammation, bone loss, exposed threads. Sometimes, we see porcelain fracture. Sometimes, we get fractured abutments, fractured screws and even fractured implants. Practitioners who have not had any of such problems on their hands probably haven’t done enough implants.
Yes, in spite of all the hype about implants lasting a lifetime, some implants do fracture after just 3 years and here is one of them. It’s one of the most uncommon complications and this is my first fracture case. As usual, the manufacturer blames it on everything except the product. But if we take a close look at the design of the implant, it is not difficult to see why this American implant might be more likely to fracture than other systems.
What wasx my reason for using this implant system? The patient has a deep bite. We’ve often been told that a fractured screw is the worst disaster you can face and implant screws are pretty small. This system does away with screws and employs a phenomenon called cold welding to hold the abutments inside the implant wells. We have been told by the experts that if biting forces were excessive, screws can break, but for this system, the abutments would just pop out. Replacing the abutments can be as simple as just tapping it back in place. They made it sound like an excellent system for patients who are bruxers, or in this case, someone with a deep bite.
Here with are with a fractured implant. The abutment post was still securely cold-welded to the fractured top part of the implant when the restoration was removed. The bottom tip of the fractured implant was still firmly embedded in bone. Something is not right. Let’s take a close look at the fractured cross section. This implant is 3.5mm in diameter. Most implants have tiny threads on their surfaces. This American system boasts of a radiator fin design and a whole list of merits based on it. However, if we look at the radiator fins - and this is the first time I had a chance to see the cross section of the implant I’ve been using for years, we’ll see that the fins run quite deeply into the body of the implant, unlike threads which only score the surface.
What is the implication? Instead of 3.5mm of solid titanium, we have only 1.6mm of solid titanium at the core beneath the implant well. This is shocking news to me. I didn’t know that the implant’s weakest point is that weak. True enough, the implant fractured at the 1.6mm juncture between 2 fins, just past the bottom of the implant well. Far from the system of choice for patients who are bruxers, this may well be the system to avoid in such cases.
In this age of compulsory continuing education where course directors and expert speakers can have vested interests in a system, dentists are as victimised as patients when fed with biased information from sponsors and manufacturers.
Implant (No) Surgery
Posted by admin in Uncategorized on December 13th, 2009
Most implants are placed into bone which has already healed over the extraction socket. This requires surgery. The gums have to be cut, a flap retracted and bone has to be drilled. The retraction of a gum flap almost always results in some pain and swelling.
To make the surgery less invasive, some dentists do it flapless. In other words, they drill straight through the gums into the bone without cutting and reflecting a flap. After the flapless operation, the patient tends to feel less pain. However, flapless surgery is “blind”. The surgeon will not be able to see if there are any perforations beneath the gums. Where bone thickness is not ideal, flapless surgery may not be safe or even possible.
What about inserting an implant into an extraction socket immediately after the extraction? If possible, the advantages are obvious. First, the patient does not have to go through implant surgery at a later date. It is flapless and relatively atraumatic. It is usually a one-stage surgery where no further surgery is required to expose the implant. As implants take 2-3 months to integrate, placing it at the time of extraction shortens healing and restoration time.
What is not so obvious, is the technical difficulty of placing an implant into an irregularly-shaped socket. When you drill a hole into a clean wall, you can control the exact depth and width of the hole. When you drill into an existing hole, it’s very difficult to control the final shape and size of that hole. It is imperitive that the surgeon gets good primary stability and is able to place a wide, socket width healing abutment over the implant at the end of the surgery. The success of immediate insertion depends very much on the surgeon’s skill and experience. It also depends on the condition of the tooth.
Immediate placement is not recommended when.
1. There is pus and acute infection.
2. The tooth is very shaky with advanced gum disease.
3. Surgical removal of the broken tooth is necessary.
The conditions for immediate placement are very similar to the conditions for required for socket preservation with Alvelac bio-scaffold (see video here) . As long as the socket is walled with bone on all sides, immediate implant insertion is possible. Forget about socket preservation. The immediate placement of the implant provides socket preservation, fewer surgeries and shorter healing time without additional costs.
Dental Implant Patient Education Video
Posted by admin in Uncategorized on November 23rd, 2009
Do you agree with everything mentioned in this dental implant video? You shouldn’t.
Tooth whitening kit ready in 1 hour
Natural looking, metal free crowns
Sleep through your dental procedure
Affordable dental implant restorations
Flexite, titanium, hybrid dentures
wisdom tooth surgery, Medisave claimable
